Why This Former Army Captain With Type 1 Diabetes Eats Low-Carb

Ryan Attar, age 37, was diagnosed with type 1 diabetes a decade ago. At the time, he was stationed overseas and serving in the United States Army as a Captain and subsequently medically discharged. Right now he is in his last year of naturopathic medical school and just finished his master’s degree in nutrition. He’ll be a naturopathic physician in Connecticut at the end of the year.

There is a small population of people with type 1 diabetes who eats a very low-carb diet like the one Dr. Richard Bernstein recommends for the purpose of “normalizing” blood sugar levels. He writes that he was lucky enough to be able to spend some time with Dr. Bernstein at his office and blogged about it on Diabetes Daily a few years ago.

Ryan says he makes no insulin endogenously according to his c-peptide tests and has been eating low-carb for about 7 years and yet, has a latest A1c level of 4.9%. He took the time to answer my questions regarding how and why he follows this way of eating.

DD: Why do you choose to eat low-carb?

I want to live complication-free. The complication of diabetes all stem from the damage that occurs during hyperglycemia. A normal, healthy eating, insulin sensitive individual is almost always between 80 to 99 mg/dL. For many people with diabetes spiking up above 120+ after meals is standard. Damage from elevated blood sugars happens much lower than most think. I like this summary of studies on that topic.

How many grams of carbs do you eat per day?

I don’t really count carbs because I just try to avoid altogether. I am definitely 30 grams or lower. Protein is always the bulk of my meals. I also eat lots of non-starchy vegetables to ensure I have all the nutrients I need. Even things like vitamin C are found in vegetables. For example, a serving of cauliflower has the same amount of vitamin C as an orange! Additionally, vitamin C uses glucose transporters to enter cells, so glucose is competitive with vitamin C, so you’re actually getting less from the orange.

I’ve found there is almost no food that can’t be made low carb. I even eat pizza, but with crusts made from almond or coconut flour, cheese, or ground chicken. They are delicious! And don’t spike me. A great resources for low-carb recipes is the Type One Grit pinterest page. Grit is a community of low carb individuals with diabetes or families with a child with diabetes. The pinterest page is organized into different types of meals like breakfasts, dinners, “breads,” and even holiday foods like Thanksgiving and Halloween.

Do you think physicians should recommend this way of eating to their diabetic patients?

Yes, they absolutely should! Sadly, most physicians, even endocrinologists who see many people with diabetes do not. Most are still stuck in the old low-fat, high-carb paradigm. Physicians who keep up with the latest research and see the outcomes of those eating this way understand the benefits of eating low-carb. Many see my A1c and equate a low A1c to hypoglycemia, but this is just not the case. When you eat low carb, you use very small doses of insulin, and have very shallow spikes. Even moderate amounts of carbs are difficult to properly cover with insulin resulting in a spike either up or down after meals. Bernstein stresses this with his “Law of Small Numbers”, small inputs (insulin and carb) small mistakes, large inputs, large mistakes. When physicians understand this, they are usually onboard for low-carb diets.

Do you use a pump or CGM?

I use a Dexcom CGM and I love it. I think everyone with diabetes should wear one. Its not perfect, and finger sticks are still needed to verify, but the technology is getting better and better especially with the latest model.

Why do you think some people don’t follow or know about low-carb eating for diabetes?

Their physicians and dieticians not giving them the option is a big problem. High-carb foods are also very addictive. But once one is weaned off them, and they see how much better they feel without roller-coaster blood sugars, people do great with the diet. What is great is that lately it is becoming popular for non-diabetics to also eat low carb. Making food options very accessible. They too realize the health benefits, especially how easy it is to stay at a lean weight.

What is your opinion on the ADA’s recommendation of an A1c below 7% for people with diabetes?

Its far too high! The goal should be for non-diabetic blood sugars and A1cs. Someone with an A1c of 7% means their average blood sugars are between 123 to 185 mg/dL. Even an A1c of 7% is an average of 154 mg/dL. These numbers are well into the range where tissues and organs are being damaged by glycation (see that summary above), the root of all diabetic complications.

Not at all. I love the food I eat! For example today for breakfast I had a veggie omelet. Lunch was a chipotle chorizo salad (hold the rice and beans), and dinner will be salmon, steamed veggies with butter and some cauliflower “rice.” Great, healthy food and my numbers will be in the 80s all day. I take small doses of R Insulin (an older, gentler insulin that covers protein perfectly) with each meal.

Anything else you’d like to say including reasons for or against low-carb eating that you’ve heard from others?

For anyone wishing to embark on a low-carb lifestyle I’d recommend joining a community like Type One Grit on Facebook. So many great people to help you along the way.

Sysy Morales is a staff writer and editor at Diabetes Daily and has lived with type 1 diabetes for 24 years. She has led dozens of diabetes education and motivational programs across the country and is a graduate of The Institute for Integrative Nutrition. Sysy started blogging about diabetes at The Girls Guide to Diabetes after the birth of her twins to share how she maintained recommended A1C levels during that time. What she has learned about diabetes dramatically improved her life and she is now obsessed with sharing information that may help other people with diabetes thrive, too.